1851871750 NPI number — KIMBERLY BERNAL LCSW

Table of content: KIMBERLY BERNAL LCSW (NPI 1851871750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851871750 NPI number — KIMBERLY BERNAL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNAL
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851871750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8215 VAN NUYS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PANORAMA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91402-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-855-2270
Provider Business Mailing Address Fax Number:
818-782-3384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28116 SMYTH DR APT 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355-4076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-954-2842
Provider Business Practice Location Address Fax Number:
818-782-3384
Provider Enumeration Date:
08/20/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  89269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 89269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 107977 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)